Cardiac surgical patients exposed to heparin-bonded circuits develop less postoperative cerebral dysfunction than patients exposed to non-heparin-bonded circuits
Cardiac surgical patients exposed to heparin-bonded circuits develop less postoperative cerebral dysfunction than patients exposed to non-heparin-bonded circuits
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DOI：
10.1177/026765910101600204
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发表时间：
2001-03-01
期刊：
影响因子：
1.2
通讯作者：
Smith, CR
中科院分区：
文献类型：
--
作者：
Mongero, LB;Beck, JR;Smith, CR
一项前瞻性随机试验被用来研究体外循环(CPB)中肝素结合回路与非肝素结合回路患者脑功能障碍的发生率。虽然术后脑功能障碍的病因存在争议。在机构批准和知情书面同意后，全身炎症反应的激活可能起到作用。对39例择期冠状动脉搭桥术(CABG)患者进行研究。分别于术前、术后5天、6周进行神经心理测试。NPMT表现的显著变化被定义为术后表现与基线相比下降25%或更多。计算每个患者的异常检查次数。首次随访采用Mann-Whitney等级检验。术后第5天，与非肝素结合组患者相比，随机使用肝素结合组的患者NPMT异常(>；1异常测试)较少(58vs70%，n=19和20)。暴露于肝素结合环路的患者在6周时异常检测(1例异常检测)较少(36vs63%)。结果提示肝素结合型体外循环可减轻全身炎症反应，可降低心脏手术患者脑损伤的发生率。
A prospective randomized trial was used to study the incidence of cerebral dysfunction in patients undergoing cardiopulmonary bypass (CPB) with heparin-bonded vs non-heparin-bonded circuits. Although the etiology of postoperative cerebral dysfunction is controversial. activation of the systemic inflammatory response may play a role.After institutional approval and informed written consent. 39 elective coronary artery bypass (CABG) patients were studied. A battery of neuropsychometric tests (NPMTs) was performed preoperatively, and 5 days and 6 weeks postoperatively. Significant change in NPMT performance was defined as a 25% or greater decrease in postoperative performance, compared to baseline. The number of abnormal tests per patient was calculated. Analysis using the Mann-Whitney rank test was performed for the first follow-up.Patients randomized to heparin-bonded circuits had fewer abnormal NPMTs (>1 abnormal test) on postoperative day 5 (58 vs 70%, n=19 and 20) than patients randomized to non-heparin-bonded circuits. Patients exposed to heparin-bonded circuits had fewer abnormal tests (>1 abnormal test) at 6 weeks (36 vs 63%. n=14 and 16).Results suggested that the attenuation of systemic inflammation by heparin-bonded CPB circuits may lower the incidence of cerebral injury in cardiac surgical patients.